Provider Demographics
NPI:1356513725
Name:SEAZONED MED TRANSPORTATION SERVICE
Entity type:Organization
Organization Name:SEAZONED MED TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-493-3133
Mailing Address - Street 1:4275 ANDERSON RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1892
Mailing Address - Country:US
Mailing Address - Phone:404-493-3133
Mailing Address - Fax:770-693-8888
Practice Address - Street 1:2809 SMITH STREET
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806
Practice Address - Country:US
Practice Address - Phone:404-493-3133
Practice Address - Fax:770-693-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)